Armanni–Ebstein Lesions in Terminal Hyperglycemia

Armanni–Ebstein lesions (AEL) occur in deaths related to uncontrolled diabetes mellitus. To investigate the relationship between AEL and terminal hyperglycemia, we retrospectively reviewed 71 cases with vitreous glucose levels ≥11.1 mmol/L; 27 (38%) cases had AEL (vitreous glucose 14.0–77.3 mmol/L); and 44 cases (62%) did not (vitreous glucose 11.1–91.9 mmol/L). There was no significant difference (p = 0.271) in vitreous glucose levels between the cases with AEL (mean 39.2, SD 16.7 mmol/L) and those without (mean 34.2, SD 19.8 mmol/L). Similarly, there was no difference in the degree of dehydration, renal failure, or osmolality. However, there was a significantly higher level of β‐hydroxybutyrate among the cases with AEL compared to those without (p = 0.007), suggesting that ketoacidosis may facilitate the development of AEL. Given the possible synergistic role of β‐hydroxybutyrate, the correlation between AEL and terminal hyperglycemia in animal studies may not be applicable to humans. AEL may also possibly occur with sublethal elevations in glucose.     

The forensic-medical expertise in craniofacial trauma

Archive materials of the recent 6 years, including 14720 death cases of victims, were analyzed for the purpose of detecting the general regularities of injuries within the craniofacial trauma (CFT). The diversity of CFT with injuries to skull bones and medullary substance was found not to interfere with establishing an actual type and mechanism of trauma provided all injuries are thoroughly and comprehensively examined. The trauma specificity must be evaluated with respect to a location and direction of traumatic force in order to define an actual impact that caused death. CFT is special variation of craniocerebral trauma, whose onset mechanism needs more research. The efficiency of forensic-medical examination of CFT cadavers directly depends on the coordination and logic of measure undertaken by expert as well as on his technical outfit and knowledge of such trauma. The diversity of variations of damage to anatomic head structures requires an interdisciplinary approach with the need to isolate a predominant chain that affects the course and outcome of trauma.     

Rape trauma syndrome

This article analyzes recent case law on the admissibility of rape trauma syndrome evidence. Because many rulings on the admissibility of this evidence have been based on judicial assumptions about human behavior, rather than on scientific evidence, we next describe psychological research relevant to concerns raised about its scientific reliability, helpfulness, and prejudicial impact. Following this review, we evaluate both the expert testimony provided and the judicial decisions in recent cases in light of current research. Finally, we provide suggestions for future psychological research that could 1 inform discussions of the admissiblity of rape trauma syndrome evidence.     

Biomechanical features of spinal trauma depending on conditions of the trauma

The aim of the study was to investigate biomechanical features of spinal trauma (fractures) depending on external impact, position of a human body or its parts in the moment of the trauma and before it; to reveal morphological signs of fractures characterizing specific trauma mechanisms. From a position of theoretical mechanics, the vertebral column is an elastic stem the strength of which depends on elastic properties of the pulpous nuclei and intervertebral disks, the column length and curvature. To determine the mechanism of the trauma, it is recommended to make the following measurements: the length of the body, the length of the vertebral column, the length of the cervical, thoracic, lumbar parts, size of the chest kyphosis.     

Blunt trauma of the abdomen in children

Abdominal trauma in children is usually due to motor vehicle accidents or falls, but child abuse is also a common cause. Injuries to the small intestine are particularly worrisome because symptoms may not appear for hours, days, or even weeks. This can cause significant difficulty for the investigator trying to determine when an injury occurred, or who may have caused it.     

Upper cervical trauma in motor vehicle collisions

Motor vehicle collisions can cause a variety of injuries in pedestrians and vehicle occupants. Fatal and nonfatal trauma to the upper cervical spine, that is, atlanto-occipital junction, atlas and axis, can be part of this spectrum. Certain distinctive injuries (for example, "hangman's fracture") which occur result from the unique anatomic structure of this area and the various disruptive forces such as extension, distraction (tension), compression (axial loading), shear, and inertia generated during collision. Correlation of autopsy findings or radiological information of these cervical injuries or both with scene investigation can be informative not only in the determination of morbidity and mortality, but also in the assessment of injury mechanisms and improvements in occupant protection.     

Extravasation of plasma proteins in brain trauma

The cellular distribution of extravasated plasma proteins in cortical contusions was studied with an immunoperoxidase method using polyclonal antibodies against human plasma albumin, alpha 1-acid glycoprotein, alpha 2-macroglobulin, alpha 1-antitrypsin, transferrin, hemopexin, haptoglobin, fibrinogen, fibronectin and immunoglobulin G. The material consisted of 24 human autopsy brains with a primary diagnosis of cerebral contusion due to blunt trauma. The time interval between injury and death ranged between minutes and 7 years. Immediately after the trauma, a complete breakdown of the blood-brain barrier (BBB) occurred with hemorrhage and extravasation of all types of plasma proteins. This was followed by spreading of edema fluid within the extracellular space in and around the wound. Uptake of extravasated protein by glial cells began on the 3rd day followed by proliferation of reactive astrocytes whose ample cytoplasm appeared to serve as a reservior for the extravasated plasma proteins. Within the reactive astrocytes, plasma proteins and S-100 protein had a similar and diffuse distribution in the immunostained sections. The plasma proteins once incorporated into the glial cells remained unchanged for several years with little sign of degradation. It is suggested that the extravasated plasma proteins subsequent to uptake and processing by the glial cells, may serve some important physiological function in wound healing.     

Healing following cranial trauma

This paper reports on the gross appearance of the initial osseous response following cranial gunshot wounds. A total of 127 adult crania and cranial sections were analyzed for four types of bone response: osteoblastic, osteoclastic, line of demarcation, and sequestration. In general, no osteoblastic or osteoclastic response was noted during the first week. This response was followed by an increasing prevalence of expression after this time. By the sixth week postfracture both osteoclastic and osteoblastic activity was scored for 100% of the sample. Further, our observations suggest that the line of demarcation may establish the boundary between the living bone and bone not surviving the fracture. Sequestration appears to be a long-term event and was scored as present well past the eighth week of healing. The osseous expression of infection following fracture was also considered.     

Combined trauma and sepsis in forensic medical practice

The relationship between combined injury and sepsis is an important problem of forensic medicine. A total of 227 cases with combined injuries have been investigated postmortem at Bureau of Forensic Medical Expert Evaluations of Moscow in 1997. Sepsis developed in 9.7% cases. The studies revealed a direct cause-and-effect relationship between mechanical injuries and development of sepsis in the overwhelming majority of cases. Sepsis may develop at any period of the traumatic disease, except the first one, and the infection is prone to generalization in the remote postoperative period.     

The shaking trauma in infants - kinetic chains

The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.     

Preventing violence and trauma in the next generation

Research in recent times has clearly demonstrated that violence is predictable and preventable; however, the primary prevention of abusive and violent behavior will not occur without personal, interpersonal, and social change. This article reviews the empirical research supporting hypotheses for primary prevention of many risks associated with children becoming abusive.     

Morphology of acute lung injuries in mechanic trauma

The lungs from 60 subjects who had died of polytrauma were studied morphologically. The heads of the corpses were not injuried. The aim of the study was investigation of characteristics and time of development of structural changes associated with lung injury. Early structural changes in trauma were disorders of circulation including microcirculation, acute emphysema, distelectases and atelectases, injury of bronchial and bronchiolar mucosa. Pulmonary edema and systemic inflammatory reaction emerge in the first hours after trauma.     

Cardiac rupture following blunt trauma

A case of cardiac rupture following blunt trauma with no additional injuries is described. This can be a difficult diagnosis because of the presence of additional injuries and the lack of clinical symptoms. Here, there was a rupture of the pericardium, all chambers of the heart and the thoracic aorta.     

Macroscopic characteristics of screwdriver trauma

The main objective of the study was to determine the type of macroscopic trauma created by a flat-tipped and a cross-tipped screwdriver. The second objective was to determine if the trauma inflicted by the two screwdrivers could be macroscopically differentiated. Three tests were conducted, each by a male volunteer. Each test consisted of 12 samples of fleshed pig ribs; six were stabbed with a flat-tipped screwdriver and the remaining six with a cross-tipped screwdriver (Phillips). Each sample received 15 stab wounds during the process. The stabbings were conducted at perpendicular and oblique angles, with fabric variables being utilized. Results illustrate two main categories of macroscopic skeletal trauma, fractures, and puncture wounds. By studying the macroscopic appearance in tandem with differing trauma frequencies, these two screwdriver types can be differentiated.     

Macroscopic characteristics of hacking trauma

Hacking trauma is often encountered in forensic cases, but little experimental research has been conducted that would allow for the recognition of wounds caused by specific weapon types. In this paper, we report the results of a hacking trauma caused by machete, cleaver, and axe weapons and the characteristics of each weapon type on bone. Each weapon type was employed in multiple trials on pig (Sus scrofa) bones and then the wounds were examined macroscopically for several characteristics that serve to differentiate the weapons.     

Asphyxia protracted after shaking trauma

A case of "shaken baby syndrome" (SBS) is reported. A 3 1/2 months old female baby has been found by his mother death in bed. The circumstances predicted a case of Sudden Infant Death Syndrome (SIDS), but the father, a disc-jockey, who had to look for the baby, had left a notice: "Gitti--i didn't want it, I don't know what had happened, I'm sorry!". The corpse of the baby had no external signs of violence. At the medicolegal examination we found small subarachnoidal and subdural hemorrhage from ruptured bridge veins and signs of prolonged asphyxia. Few hours later the father could be arrested. He told that he had shaken the baby, because she didn't stop crying. The infant lost conscious and he layed him down to the bed with his face below. Then he looked TV for at least a few minutes. After insufficient reanimation he had left the house. The court found the man to be guilty of fatal infant child abuse and convicted him to detention of 8 months. The main signs of SBS are discussed (subarachnoidal and subdural hemorrhage, intraretinal and periretinal hemorrhages, brain edema). Especially in the german speaking Europe many medical examiners are not familiar with this form of infant child abuse.